A Critical Review of the Fiscal Repercussions of the ACA

An interesting article I read this month, published in The Wall Street Journal, discussed the financial implications of the Affordable Care Act and provided an interesting point that had been brushed upon but not examined in class. The article, entitled “Medicaid Expansion Is Proving to Be a Bad Bargain for States”, does show a bias which is usually not overly credible, however, its point is well supported. Continue reading “A Critical Review of the Fiscal Repercussions of the ACA”

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Everyone’s Health Records… All In One Place?!

http://www.fastcompany.com/3054027/elasticity/ge-wants-to-move-all-your-health-data-to-the-cloud

In this day and age, everything is computerized and shared virtually, whether it be pictures, videos or notes. However, medical records are usually lost between hospitals, and patients find that they’re required to get the same CT scan that they did months ago at another hospital, doubling their exposure to radioactivity as well as accumulating ridiculous amounts of costs. Luckily enough, GE Healthcare has introduced a service that could fix this problem altogether – a service they call GE Health Cloud that links up “medical devices around the world, processes the data, and stores patient records securely online so they can be viewed from anywhere” (Captain, par.4). Indeed it’s true that something of this magnitude has the possibility of violating patients’ confidentiality, but the company promises that Health Cloud meets all U.S. HIPPA privacy requirements for healthcare records. GE Healthcare is planning to launch their new service in late spring 2016, revolving around devices like “CT scans, ultrasounds, and MRI scanners, and starting off with 500,000 of GE’s machines” (Captain, par.5). De Witte, the president and CEO of GE Healthcare, emphasizes that this service could save time and money, as well as even save lives. He gives the example of a patient with an ischemic stroke, which requires immediate diagnosis and treatment within 3-4 hours. A CT scan would require at least 4-5 hours, and the duration would put the patient’s life at risk. But with this service, any of the patient’s radiological records can be examined within minutes using the Health Cloud. The problem will eventually come with the hospital’s decisions to participate in the service, which can obviously be costly to the hospitals. It’ll be a difficult problem to come across when one hospital decides to participate in the service, and another hospital decides to ignore it.

I think this is one of the most promising articles I’ve come across in a long time. Medical technology is always being reinvented and expanded, so it’s shocking that a service like this hasn’t already been created. The biggest obvious downside to this service will indeed be the costs that hospitals will have to manage, but this is a situation where the positives greatly outweigh the negatives. Aside from saving the patient a great deal of time, effort, and money, this could ultimately save a patient’s life (as explained in the paragraph above) as well as help the patient’s health in ensuring they aren’t overly exposed to unnecessary and redundant radioactivity that comes from many of these scanners. I am, however, skeptical of how every hospital will react to this service. I do believe many will reject this service solely based on costs, but if the costs are evenly distributed between the hospital and patients, I feel that the costs would end up being reasonable for both parties, still saving patients money from the ridiculous costs that come with all these expensive tests. I look forward to following up on the service’s success

Rise in Early Cervical Cancer Detection Is Linked to Affordable Care Act

Earlier in the semester we watched a documentary about how health care coverage varied based on age. The highest rate of uninsured Americans were between the ages of 18 to 25. Most were unable to afford healthcare because they didn’t have access to employer-based health plan and were not covered by their parents’ health insurance. Health and finances of young Americans were at risk. In 2010, the provision of the Affordable Care Act allowed young adults to stay on their parents’ insurance until the age of 26. The number of uninsured adults in this age group declined significantly.

Continue reading “Rise in Early Cervical Cancer Detection Is Linked to Affordable Care Act”

Pharmaceutical Price Hike: Only 66,566%

Cancer. It is a word the strikes fear in the hearts of many as many still equate being told one has cancer with one being given a death sentence. From that point on, one becomes somewhat of a living time bomb. However, for you, the cancer has been caught early on enough that you can still get treatment to combat the deadly illness. Immediately, one’s thoughts then go to how much will this treatment cost? For someone without insurance, the costs could be crippling. Imatinib is from a class of drugs commonly used to combat cancer. In the United States, a single year’s worth of treatment can cost upwards of $106,000. Luckily, you live in India.

In India, a year’s worth of treatment using Imatinib costs around $159. The difference between the costs for this type of drug between India and the United States is a price hike of over 66,566%. That’s right, five digits. A recent review of drug production costs and pricing presented this past September at the 2015 European Cancer Congress mapped out the money an individual would spend for a year’s treatment of three classes of drugs commonly used to combat cancer: Imatinibs, Erlotinibs, and Lapatinibs. In addition, these prices are already allowing for a 50% profit margin for pharmaceutical companies. The main reason why these life-saving drugs are cheaper in both India and in Europe (the price hike between Europe and the United States for Imatinib hovering at around 231%) is because generic versions of the drugs using Imatinibs are so much more readily available in India. The article takes the specific example of Gleevec, a drug used by people with leukemia and gastric cancer. Its patent, first approved by the FDA in 2001, should have expired this year. However, Novartis, the pharmaceutical company who has the patent, has managed to keep other companies trying to make generic version at bay by making the large amounts the drug needed to synthesize a generic version hard to attain by these other companies. This is a problem faced by many pharmaceutical companies as they try to produce cheaper generic versions of much more expensive drugs. The reason why expensive drugs are able to stay expensive is because there are no other competitors. As a result, people with these illnesses (usually more rare and not as researched) are forced to buy these expensive drugs as they have to alternative drug to turn to.

Why then, are these cancer drugs so much cheaper in India? With not as many restrictions within drug production and with drugs being so readily available, companies are able to attain enough samples to create many different generic versions of a single drug. As a result, the buying medication in India is more of a true free market as consumers can see how expensive each drug that would do the same thing is. Companies are then either forced to lower prices to beat out their competition or risk going out of business. As it would not really be beneficial for anyone (but Pharmaceutical companies) to lower drug production restrictions, the more feasible solution for the United States would be to put a cap on prices for each specific type of drug. Adopting something similar to Canada’s pharmaceutical policy where certain drugs cannot be sold within the county unless the price can be negotiated to a suitable arrangement would get affordable life-saving medication to those who need it the most without making them have to move halfway across the world to receive it.

http://www.forbes.com/sites/elaineschattner/2015/11/24/why-many-new-cancer-drugs-dont-have-to-cost-so-much/

Punishing “Good” Hospitals

As most health experts would agree, the quality of health care is exceptionally diverse and can be characterized by many independent factors.

For example, the level of experience that doctors have at one hospital can significantly impact mortality rates in a given year. Similarly, the locations of these hospitals can also play a role in whether or not patients will receive specific treatments and medications. Hospitals on the other hand have no incentive to provide the best quality of care to its patients other than moral obligations. Therefore, the federal government has finally stepped by providing Medicare with more leverage. Medicare, which serves as a federal insurance program for people over the age of 65, introduced a value-based purchasing program (VBP), which would allow the government to pay certain hospitals for their quality of health care. However, critics have censured the program, stating that the requirements for the additional compensation are biased against hospitals in smaller, under-privileged areas. While the financial incentive may seem reasonable, the system may cause greater economic separations between hospitals.

One of the main problems with VBPs is the effect on safety net hospitals. Safety net hospitals are hospitals that provide health care to a majority of low-income families. Often times, these hospitals are financially strained because their patients cannot afford the medical bills. While the quality of care may be equivalent or even greater compared to higher-end hospitals, safety net hospitals receive poor patient satisfaction ratings because of the lack of services and facilities that other hospitals have. Therefore, the disparity between hospitals is exacerbated due to the fact that VBPs will take notice of only high rated hospitals, regardless of what particular situation some of these hospitals are in. In doing so, these programs are indirectly punishing hospitals for providing care to poorer people. Even more so, a financial incentive is created to ignore patients who are unable to pay for their hospital bills.

The intentions of the VBPs were well planned and the program was a strategic way for the government to ensure the best quality care from hospitals all across the country. By providing a financial incentive for hospitals to increase quality of care, it would potentially reduce certain problems like over and under-treatment. However, the biggest problem with the system was rewarding hospitals solely on patient satisfaction surveys. These surveys are highly vulnerable to bias and would not benefit many hospitals that actually need the additional subsidy. For instance, one aggravated patient may score a hospital low due to far less important reasons such as an unsatisfying hospital meal or the lack of television in the recovery room. These patient biases would then become poor indicators of health care quality. Some hospitals that emphasize meeting the personal patient needs rather than overall care would be unfittingly rewarded. Other hospitals that need financial aids to compensate for patients who do not pay may not receive additional grants at all even with identical quality treatment. Therefore, I believe putting more emphasis on statistical information, such as cost-efficient procedures and reductions in mortality rates, would be more appropriate. Unlike patient surveys, numbers often demonstrate the quality of health care in a much more objective perspective.

Article:

http://www.forbes.com/sites/peterubel/2015/10/16/paying-for-patient-satisfaction-harms-hospitals-that-care-for-poor-people/

Alternatives to the Chargemaster?

In Steven Brill’s article, “Bitter Pill: Why Medical Bills are Killing Us,” he describes the chargemaster as “every hospital’s internal price list,” which is then used in patient bills to calculate the final cost of care. Because each hospital is free to determine their own chargemaster and there is no regulated process for doing so, these chargemasters often have grossly inflated prices for services, especially when compared to the prices for services paid for through Medicare or Medicaid. This leaves every American not on either of those programs to flounder with astronomically high medical bills. Even with insurance negotiating prices down from that chargemaster starting point, charges for services are still many times higher than they cost the hospital to provide. To combat this, Brill says that we must “outlaw the chargemaster” and also “amend patent laws” to limit the power of pharmaceutical companies charging high prices for ‘their drugs,’ “set price limits or profit-­margin caps” on drugs, and cap profits for CT and MRI scans and for in-house lab tests. He also suggests medical-malpractice reform, capping administrative salaries in the medical field, and posting profit margins publicly.

I think that Brill’s suggestions are wonderful, but he does not say enough about how we can manage to make all of these changes happen. So, that is my question: how do we get from where we are now to a world of no chargemasters, legal reform, and caps on costs and salaries?

Why can’t we adopt a different healthcare system?

The film in class allowed me to view other countries’ healthcare systems and compare them to our own here in the United States. I was surprised to find that even though we are a well developed country, we still struggle to give people access to healthcare, as well as,  lower our healthcare spending. The UK has a system that is funded by tax revenue and Japan is somewhat similar except there are competing players. Why can’t the US adopt a similar plan that allows access to all Americans regardless of age, employment status, or income but still keep the market open? The US spends more than any other nation on healthcare costs alone. Why have other nations figured it out when we are moving slowly to change? A hospital president in Japan even commented on the high medical costs in the US by saying “being put in debt because of healthcare is unheard of.” This is astounding because in the United States, there are many people who are suffering from debt due to hefty medical bills. Japan also has regulated costs. These medical prices cannot be raised for no reason.

Process Reflection 1

Through the readings and conversations in both lecture and discussion, the apparently “flawed” US healthcare system has now become apparent to me. The biggest eye opener of this course thus far is the fact the US healthcare is revolved mostly around money, that being either how is the doctor or how is the institution being paid. When I say eye opener I should clarify; I knew that US healthcare, being a private sector, was mostly about money but after the readings and discussions I never thought it was this bad.

Continue reading “Process Reflection 1”

Process Reflection 1

The Sociology of Healthcare class and the materials covered have opened my eyes to the corrupt and unjust nature of the United States Healthcare system. Before taking this class, I was not very familiar with the healthcare system or all of the different types of coverage or even the history of healthcare or insurance policy. Today, I have a better understanding of the healthcare system and the way it is organized. After reading about different healthcare plans and different experiences in the system,  I often look back at my own healthcare experience for context. However, I feel that I am unique in the sense that my coverage is provided by the government; specifically the military. This system is not perfect by any means but I have not had a problem gaining access to healthcare and have never had to pay any off the wall charges. For instance, I had a thumb surgery for a tumor removal. The bill came out to $6,000 but my family only had to pay a small copay of about $40.

I do not pay for individual visits to see a healthcare provider and medications are also covered under my insurance. I simply cannot imagine being an individual who does not have insurance or who is denied coverage. Why is it so difficult to convert to an overarching system that provides access and care to all people regardless of income or age? If it is costing us billions of dollars each year then why can’t we find any cheaper alternatives or stop over-utilizing and wasting money on unnecessary procedures and tests? This fact alone makes me think that the healthcare system is not in the business of making people better but instead is in the business of profiting from illness. For example, the article that struck me most was the article that discussed the “chargemasters” payment system. This was a database that determined cost of services from surgeries performed and down to the instruments being used.  It surprised me that this database basically came from no where. It was based on theory and had no real context. This makes me question who really determines cost? Why is there so much inflation?

Our healthcare system needs a serious overhaul.  Who or what will change it? Only time will tell.

National Healthcare Unconstitutional?

Brill calls attention to the method in which our healthcare prices are set. He states healthcare consumers are “powerless buyers in a sellers’ market where the only consistent fact is the profit of the sellers”. It is a fact that prices and rates in our system vary immensely throughout the country. Many parties, such as the pharmaceutical market, have taken advantage of how the system has been set. Interestingly, the difference in prices does not significantly affect the quality of healthcare at all. While a national healthcare system has been proposed in the past, the Supreme Court has regularly called it unconstitutional. Therefore, how could our system be reformed so that healthcare prices are similar nationwide while still being constitutional?